摘要
[目的]比较固定平台假体(FB)与旋转平台假体(RP)应用于人工全膝关节置换术(TKA)治疗终末期膝骨关节炎的效果。[方法]2014年6月~2015年6月本院骨科收治的终末期膝骨关节炎患者86例,所有患者均行全膝关节置换术,根据受试者选择置换假体的意愿分为FB组(共40例)和RP组(共46例)。记录比较两组围手术期情况(包括手术时间、切口长度、术中失血量、术后引流量、下地时间等)及术后并发症发生情况,比较术前及末次随访时两组KSS评分、疼痛评分及髌骨评分,并摄膝关节X线片进行影像学评估。[结果]两组患者的手术时间、切口长度、术中失血量、术后引流量及下地时间比较,差异均无统计学意义(P>0.05),RP组术后6 d发生脱位1例,处理后未再发生脱位,随访未发现其他严重并发症;两组末次随访KSS评分、膝评分及功能评分、疼痛评分、髌骨评分均较术前显著升高(P<0.05),末次随访组间同期比较差异无统计学意义(P>0.05);术后正侧位X线片显示两组术后假体位置均良好,无松动,末次随访膝关节活动度较术前显著增大,胫骨角较术前显著减小(P<0.05),末次随访组间膝关节活动度、胫骨角同期比较差异无统计学意义(P均>0.05)。[结论]RP与FB应用于TKA术治疗终末期膝骨关节炎均可显著改善膝骨关节功能,术后膝关节疼痛明显改善或消失,膝内外翻等畸形得到改善,疗效显著,安全性高。
[Objective] To compare the clinical outcomes of fixed bearing(FB) prosthesis versus rotating platform(RP) prosthesis applied in total knee arthroplasty(TKA) for end-stage knee osteoarthritis. [Methods] A total of 86 patients with endstage knee osteoarthritis received total knee arthroplasty in our hospital from June 2014 to June 2015. Based on subjective willingness of choosing prosthesis, 40 patients had fixed bearing(FB) prosthesis used, while the remaining 46 patients had rotating platform(RP) prosthesis implanted. The perioperative data, including operation time, length of incision, intraoperative blood loss, postoperative drainage, bed rest time and postoperative complications were recorded; additionally, the KSS scores, pain scores and patellar scores, as well as radiographic parameters were used for evaluation of outcomes. [Results] There was no significant difference in operation time, incision length, intraoperative blood loss, postoperative drainage and bed rest time between the two groups(P>0.05). One patient in RP group suffered from dislocation at 6 days after operation and no recurrence of dislocation occurred after close reduction. No other serious complications were found in anyone of them during the follow-up. The KSS score, pain score and patellar score at the last follow-up in both groups were significantly higher than those before surgery(P<0.05), despite no significant difference in any corresponding time points between the two groups(P>0.005). The postoperative anteroposterior and lateral X-ray films showed the prosthesis position was in good position with loosening in both groups.Compared with that before operation, the knee joint mobility at the last follow-up significantly increased, but tibial angle significantly decreased(P<0.05). However, there were no significant differences in knee mobility and tibial angle at any corresponding time points between the two groups(P>0.05). [Conclusion] Both the FB and RP prosthesis TKA do significantly relieve pain, correct knee deformities and improve the function for end-stage knee osteoarthritis.
引文
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